Iron deficiency without anaemia

Iron deficiency without anaemia is three times as common as iron deficiency anaemia. Studies in females, adolescents and youth have shown that iron deficiency without anaemia has a number of clinical consequences similar to IDA, including fatigue, impaired concentration and decreased work productivity. There is a lack of research regarding the effects of iron deficiency without anaemia in males.

There is no consensus on whether these patients should be investigated; however the British Society of Gastroenterology guidelines(1) tentatively recommend:

  • coeliac serology in all patients
  • reserving other investigation for those with high risk profiles (eg, age >50 years) after discussion of the risks and potential benefits of upper and lower GI investigation (C)*
  • treating all others empirically with oral iron replacement for 3 months and investigation if iron deficiency recurs within next 12 months (C).*

*Level C evidence. British Society of Gastroenterology Guidelines for the management of iron deficiency anaemia, 2011.


Spectrum of iron deficiency

Absolute iron deficiency results from extensive negative iron balance, culminating in decreased or exhausted iron stores. Sequential stages are: normal iron status to iron depletion (depletion of storage iron) to iron deficient erythropoiesis (red cell production affected but haemoglobin still within normal level) and finally iron deficiency anaemia.

07 LRI Spectrum of iron deficiency without header - 900 px wide.png

    1. Goddard AF, James MW, McIntyre AS, Scott BB on behalf of the British Society of GastroenterologyGuidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–1316. Available from:


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